We conducted a cross tabulation and text mining analyses using the survey conducted in 2020 of speech-language-hearing therapists (STs) engaged in audiological services, to examine the activities of these therapists. Tasks related to hearing aids and cochlear implants tended to be less common at educational facilities than at medical or welfare facilities. At medical facilities, there were differences in the contents of tasks depending on the department to which they belonged. However, there was little difference in the work status between full-time and part-time workers. Among audiological examinations, not many of the STs perform electrophysiological testing, indicating a division of labor with other medical staff. In terms of multidisciplinary collaboration, there was little collaboration with schoolteachers and nursery schoolteachers among STs involved in pediatric language and hearing loss at medical facilities. In postgraduate education, a shortage of mentors was evident, and many STs who deal with adults thought it necessary to increase educational and employment opportunities for the cochlear implant field in order to prepare for the increasing number of cochlear implant users, while STs who deal with children thought it necessary to provide a place for practical clinical experience and to create a know-how to collaborate with local educational facilities.

　 There are many people with even mild to moderate hearing loss who do not fall within the scope of ‘Persons with Physical Disabilities’ under The Act for the Comprehensive Support of Persons with Disabilities, there is no national governmental support system for such people. Two fact-finding surveys conducted in early 2021 revealed that while the local governments' own subsidy systems were expanding, there were also large regional differences. Hearing aids are expensive medical devices, so that a seamless nationwide support system with no regional differences should be established for people with mild to moderate hearing loss, regardless of whether they qualify as persons with physical disabilities or not.

　 Approximately 60% of children with hearing loss have mild to moderate hearing loss that does not qualify them as persons with physical disabilities. In recent years, social systems such as early diagnosis by newborn hearing screening, initiation of rehabilitation, and introduction of subsidies for hearing aids for children with mild to moderate hearing loss have been expanded. Children with mild to moderate hearing loss generally have good hearing and language development, and many of them are enrolled in regular schools and classes. On the other hand, however, hearing ability, language development delay, decline in academic ability, and social problems occur frequently, and tend to become more pronounced and complicated complex with age. Children with mild to moderate hearing loss seem to have little trouble communicating at first glance, so in inclusive education settings, they often do not receive appropriate interventions or appropriate understanding and support from educators. It is desirable to build a collaborative support system and share information, so that in addition to rational consideration and understanding of issues at school, specialized examinations and guidance by speech pathologists and hearing support school teachers [will “hearing support school teachers” be understood by the reader?] can be used together.

　 Presbycusis causes communication disorder, which could lead to an unfavorable relationship with coworkers and difficulties at the workplace.　

　 Hearing compensation should be considered depending on the degree of hearing disability in daily and social life. People with sensorineural hearing loss have difficulty in communicating due to imperfect audibility and the impaired frequency and temporal resolution. Furthermore, in the presence of decreased cognitive ability in elderly people, it becomes even more difficult to understand conversations. Hearing aid users, especially elderly people, require auditory rehabilitation to improve their ability to listen and communication to acquire compensatory strategies. Herein, we provide an outline of auditory rehabilitation for adult users of hearing aids, and discuss the importance of auditory rehabilitation and the clinical support of doctors and speech-language-hearing therapists.

　 In recent years, there is an increasing demand for countermeasures for problems associated with hearing loss in Japan. The government and relevant academic societies have been calling for active involvement of speech-language-hearing therapists. It is expected that the participation of speech-language-hearing therapists would contribute significantly to auditory health.

　 At our outpatient clinic, hearing aids are fitted using the “Utsunomiya Method,” which has recently been implemented at several facilities in Japan for auditory rehabilitation. The main features of this method are “the full-time use of hearing aids from day 1 of rehabilitation, with frequent testing and adjustments for the initial 3 months,” and “having a dedicated speech-language-hearing therapist specialized in audiology at the hearing aid outpatient clinic”.　

　 Initially, we set up a hearing aid outpatient clinic with only one otolaryngologist for a year. The otolaryngologist in charge provided all the services, including hearing aid adjustment, fitting instruction, and auditory rehabilitation. Thereafter, a speech-language-hearing therapist was employed to provide these under the supervision of the otolaryngologist. We conducted a comparative examination of the impact on the patients, otolaryngologists, and the hospital management before and after the change in the clinic setup was implemented. We analyzed the data of a total of 409 subjects who underwent auditory rehabilitation at the hearing aid outpatient clinic in Keiyu Hospital, Yokohama, Japan, between April 2016 and November 2020. The average score of patient satisfaction with hearing aid use after auditory rehabilitation was 82 out of 100 before the change, and 80 after the change, hence we were able to maintain a high standard throughout. The number of patients accessing the service had increased from 14 to 54 per week, yet, we managed to reduce the working hours of the otolaryngologist at the hearing aid clinic. Moreover, the annual number of functional hearing aid assessments conducted had increased by 3.2 fold. Despite the change from an otolaryngologist-led to a speech-language-hearing therapist-led clinic set up, we were able to maintain a high level of patient satisfaction while reducing the burden on the doctors, delivering an increase in the hospital's revenue. We found that active involvement of speech-language-hearing therapists allows for better hearing aid care.

　 We examined 124 children under 18 years old with bilateral sensorineural hearing loss who visited us for 4 years. First, we examined the contribution of neonatal hearing screening (NHS) to the detection of pediatric hearing loss. Infants aged 0 year at the first visit accounted for 54% of the subjects; 99% had undergone the NHS and 82% had failed in both ears. In the overall subject population (0 to 17 years of age), 83% had received NHS and 54% had failed in both ears. Next, we investigated the grade of hearing loss and application of the auditory compensation system. Audiological examination revealed profound, severe, moderate, and mild sensorineural hearing loss in the better hearing ear in 15%, 12%, 51%, and 14% of the children, respectively. Eight percent of the subjects had hearing loss in partial frequencies. The prevalence of wearing hearing aids was 20%, 63%, 83%, and 100% in children with partial, mild, moderate, and severe hearing loss, respectively. Among children with profound hearing loss, 74% received cochlear implantation and 26% used hearing aids.　

　Only 54% of children with bilateral sensorineural hearing loss had failed in both ears at the NHS. More than 70% of children had moderate or less severe hearing loss, which are not covered by the Services and Support for Persons with Disabilities Act in Japan. It is necessary to enhance the system for detecting pediatric hearing loss after NHS and provide continuous support for children with various degrees of hearing loss.

　 The purpose of this study was to investigate the basic perceptual abilities related to melody, including pitch and pitch pattern, and the characteristics of strategies used for melody recognition in patients with cochlear implants. A total of 28 adults who developed deafness and underwent CI in adulthood and 34 children who underwent cochlear implantation by three years of age participated in this study. All participants underwent the tasks of pitch discrimination, three-sounds pitch pattern discrimination, and melody recognition. The results showed that the children with CIs performed significantly better than the adults with CI on the pitch discrimination and pitch-pattern discrimination thresholds, while both groups experienced difficulty in identifying melody. Analysis of the melodic confusion matrix showed that the adults with CI frequently made errors within the same rhythm, but different melodies. It was speculated that adults with CI might effectively use the rhythmic cues to integrate melodies they memorized when the hearing was normal. On the other hand, children with CI showed no specific tendency in melodic recognition. The results indicated that the melody that persons with CIs hear and learn may not be the same as those that hearing individuals hear and learn. Multiple regression analysis showed a positive correlation between the pitch discrimination threshold and speech recognition as well as the age at onset of deafness and CI.